Amniotic fluid embolus: Difference between revisions

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==Pathophysiology==
==Background==
# release of amn fluid to maternal vessels during intense ut contractions or manipulation or at areas of placental separation.
*Diagnosis of exclusion
# most common during labor
*Maternal mortality rate ~80%; 85% of survivors have neurologic sequelae
# leading cause of death during induced abortions
 
# can also be spontaneous or blunt trauma with abruption
==Risk Factors==
# also post amniocentesis
#Cesarean delivery
#Advanced maternal age
#Abnormal placental implantation
#Uterine rupture
#Eclampsia


==Diagnosis==
==Diagnosis==
# 2 or 3 trimester
#Any of the following:
# ut contraction or manipulation
##Respiratory distress
# sudden hypotension, hypoxia, or coagulopathy
##Pulmonary edema
# triggers immunological response
##Hypoxia
# death by vasospasm, release of vasoactive substances, mechanical plugging of mat pulm vasc tree
##AMS
# get ARDS and L vent dysfnctn
##Seizures
# fetal hair, squamous epithelial cells and debris in mat circulation
##Sudden maternal cardiovascular collapse
##DIC
 
==Management==
#Treat hypoxia
##NRB or intubate
#Treat hypotension
##Pressors / blood products
#Avoid hypoperfusion
##Place pt in left lateral decubitus position
#Immediate delivery of fetus:
##Perimortem C-section w/in 5min of cardiac arrest if mother cannot be resuscitated


==Source==
==Source==
7/09 PANI
Tintinalli


[[Category:OB/GYN]]
[[Category:OB/GYN]]

Revision as of 02:16, 25 August 2011

Background

  • Diagnosis of exclusion
  • Maternal mortality rate ~80%; 85% of survivors have neurologic sequelae

Risk Factors

  1. Cesarean delivery
  2. Advanced maternal age
  3. Abnormal placental implantation
  4. Uterine rupture
  5. Eclampsia

Diagnosis

  1. Any of the following:
    1. Respiratory distress
    2. Pulmonary edema
    3. Hypoxia
    4. AMS
    5. Seizures
    6. Sudden maternal cardiovascular collapse
    7. DIC

Management

  1. Treat hypoxia
    1. NRB or intubate
  2. Treat hypotension
    1. Pressors / blood products
  3. Avoid hypoperfusion
    1. Place pt in left lateral decubitus position
  4. Immediate delivery of fetus:
    1. Perimortem C-section w/in 5min of cardiac arrest if mother cannot be resuscitated

Source

Tintinalli

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